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FOR OFFICE USE: C r^ APPLICATION FOR SANITATION -PERMIT �. t---------------- ......... 1--- Permit No. ..74. ....... f__. (Complete in Triplicate) D e I .,,y `s'�Tli s Permit Ezp1reiYear 3 Fr`o`'in bate Issued a ss ued 5. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is.made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION f _.,l E.. �,� /�'-. ...... .... -�� . -��.. _. �.....:...........CENSUS TRAGI` .............. Owner's Name ............. .....................................-Phone ................................ Address _ 5"a477 _.__...._ City �� --- .... .. Contractor's Name ......XZ.� _- -. .1�Z �e-t---------------------------- -----------License # li; 14. Phoney � :... Installation will serve: Residence ❑Apartment House C❑ Commercial OTraller Cvwrt kMotel ❑Other ...................................... Number of livingunits:.._ ..___..- Number of bedrooms ___ Garbo a Grinder l � Z_—Garbage /._P11._. Lot Size -..�G-��-�----------------•----• Water Supply: Public System and name ................. ...•••---.......-_._....---• ...............................................................Private Character of soil to a depth of 3 feet: SandT] Silt❑ Clay ❑ -Peat'D Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ja Fill Material ----_----- If yes,type ............................ (Plot plan, showing size of lot, location of- system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer:is available within 200 feet,) r a PACKAGE TREATMENT [ ] ~ I lSEPTIC TANK � ......... Liquid Depth . y Ca acit T e Material. No. Compartments Distance to nearest: Well ...........?4 ................Foundation .� __....._ Prop. Line ,,� ..........._. F - -- tLength of ach lin ---�.......: .....:.. Total Length �� LEACHING LINE No. of Lines fe" Total 'D' Box . Type Filter Material .Depth Filter Ma ........... Distance to nearest: Wall ..(�'..��.�.�..__._.._ Foundation ,.t�.�?.�_......__ Property Line ..1�.................. D SEEPAGE PIT j Depth .................... Diameter _._...__........ Number ._._...`_....._..... ..... Rock Filled Yes ❑ No Water Table Depth "' *...:....:........Rock Size Distance to nearest: Well .____.....-_:...........................Foundation .................. '.Prop. Line ....................._b REPAIR/ADDITION(Prev. Sanitation Permit# ."':......... Dote .................................... c Septic Tank )Specify Requirements) ............... ............... ......_........................................ ........._...........•...... ' DisposalField (Specify Requirements) ..........................-------------------------------------------------------------------......................................... p. h ...................................... -...-.----------•--•---•-.----------- ---------- ----...__............_...................... ......... ..................•--------- JDraw,existingand required addition on reverse side) I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hence owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of Californias" - - Signed ............... ..... ............... Owner By ........:.......... . ....... r Title- -_ . ::.: �.. other than owner) FOR DEPARTMENT USE ONLY APPLICATION g;ACCEPTED BY ------..-.......................... . DAVE 6 6'7`2..K BUILDINGPERMIT ISSUED ................• ...---•---------•••-----...-•---.....................................................DATE ........................................... ADDITIONALCOMMENTS ---------------------•....---........ ........................................................ •... __..- •`. -----•------I........... ................................ .c ................................................................................................................ ... ------..--•------------------- : ....... Final inspection by: ...-. _.. � .rL .Date �. :^'7 ............. ....... •• .. ....................... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7172 3 .H ?